Provider Demographics
NPI:1063768547
Name:TREECE, JANA GAIL (PHARMD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:GAIL
Last Name:TREECE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:TREECE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10155 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8290
Mailing Address - Country:US
Mailing Address - Phone:318-773-5520
Mailing Address - Fax:
Practice Address - Street 1:3710 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2130
Practice Address - Country:US
Practice Address - Phone:318-841-6416
Practice Address - Fax:318-769-0809
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019812183500000X
TN37023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.019812OtherLOUISIANA BOARD OF PHARMACY
TN37023OtherTENNESSEE BOARD OF PHARMACY
LA2305841Medicaid